Bacground/Aim. Treatment of neurological diseases usually requires polypharmacy, and it is crucial to detect potential drug-drug interactions (DDIs) and recognize risk factors on time, as consequences of DDIs could be serious. The aim of the study was to analyze risk factors for the occurrence and the number of potential DDIs among patients in a general neurological ward. Methods. This study was conducted with 144 inpatients in a general-care neurological department of a tertiary care hospital. The effects of risk factors for potential DDIs were evaluated by multiple linear regression. The study had retrospective cohort de-sign. Frequencies of various types of potential DDIs (according to severity) were discovered by Medscape, Epocrates and Micromedex online interaction checkers. Results. The number of prescribed drugs, age of a patient, value of the Charlson comorbidity index and prescription of an antidepressant increase risk of potential DDIs in a general neurology ward. On the other hand, being paralyzed, number of prescribers for a single patient, being bedridden for at least one day of hospitalization decreased the number of potential DDIs per patient. Number of prescribed drugs per patient [odds ratio (OR) = 1.466 ? 0.250; p = 0.000) and age (OR = 1.027 ? 0.026; p = 0.041)] increased, and number of prescribers per patient (OR = 0.056 ? 0.028; p = 0.016), especially if the patients were paralyzed (OR = 0.214 ? 0.294; p = 0.007), decreased the risk of contraindicated, serious, ?use alternative? or major potential DDIs. Antidepressants increased the risk of absolute number of all monitor/modify potential DDIs (OR = 1.257 ? 0.726; p = 0.035). Conclusion. Frequency of potential DDIs among neurological patients is considerable and influenced to the largest extent by advanced age, comorbidities, total number of pre-scribed drugs per patient and concomitant use of antidepressants.
Introduction: The clinical significance of potential drug-drug interactions (pDDIs), especially in the intensive care unit (ICU) manifested mostly as adverse drug reactions. Aim: The goal of this research was to conduct a focus group, in which the participants were decisionmakers in acute ischemic stroke patient treatment. Also, the aim was to reach a consensus, due to the Delphi process, between neurologists and clinical pharmacologists regarding this highly vulnerable group of patients. Material and Methods: In this academic research, so-called applied focus group (the goal was to reach practical decisions) and clinical focus group (determining motives, predeterminations, bias, prejudice and analyzing the behavior leading to a certain outcome) was done. Results: Continuing medical education of neurologists is needed regarding pDDIs and the use of an online pDDIs checker. Certain groups of patients with AIS are at particular risk of exposure to pDDIs. Certain drug groups are more likely to interact with other drugs. Conclusions: Defining medical recommendations/guidelines on evidence base medicine about pDDIs in patients with AIS would significantly contribute to reducing their frequency in this vulnerable patient population.
Introduction: Patients with Parkinson's disease are exposed to higher number of drugs on average than other elderly persons. Levodopa, of the mainstay of Parkinson's disease therapy, is frequently interacting with numerous drugs. Aim: The aim of this study was to identify predictors of potential drug-drug interactions (pDDIs) in hospitalized patients suffering from Parkinson's disease (PD). Material and Methods: This was a academic retrospective cross-sectional study in PD patients hospitalized at the Clinic of Neurology, Clinical Center Kragujevac. Medical records of hospitalized patients during the period 1.1.2017 - 31.12.2019 were analysed. The pDDIs were identified by means of Micromedex andLexi-Interact online softwares, and multivariate regression methods were used to reveal potential predictors of number of pDDIs per patient. Results: Micromedex detected 160 different pDDIs in 77.8% of 72 patients with PD. The most frequent pDDIs were those that involved aspirin (with bisoprolol, sertraline and perindopril). Predictors of pDDIs in general was total number of drugs, while use of antidepressants presented a significant risk factor for major pDDIs. Lexi-Interact revealed 310 pDDIs in 98.6% of patients. The three most common pDDIs were with levodopa (bisoprolol, clonazepam, perindopril). Total number of drugs, number of co-morbidities, hospitalization at the neurodegenerative ward, and use of antipsychotics were identified as the relevant predictors of pDDIs. Lexi-interact software detected significantly more pDDIs than Micromedex (p<0.001). Conclusion: Neurologists should pay special attention when deciding whether to administer new drug to a PD patient with multiple comorbidities, hospitalized in a neurodegenerative ward and/or taking antidepressant or antipsychotic drugs.
Irritable bowel syndrome (IBS) is a functional gut brain gastrointestinal (GI) disorder, typically accompanied by constipation or diarrhea, usually without any organic evidence. The prevalence of IBS is rather high of about 10-15% (10, 1 % according to Rome III and 4, 1% according to Rome IV, Enck P. et al 2016, Sperber A.D. et al 2020, Black C.J. et al 2020) in the working population. Quality of life in patients with IBS is reduced and therefore a major obstacle to the normal physical and social wellbeing. In intensified clinical research worldwide new pathogenic mechanisms of IBS are suggested, including intestinal dysbiois one of the critical contributing factors to onset or further development of IBS. Intestinal microbiome represents a real ecosystem of microorganisms and human GI tract lining cells. The diversity and composition of the GI microbiome may differ significantly inter- and intra-individually, depending on sex, age or physiological conditions (pregnancy, disease, etc). Intestinal microbiome composition frequently changes in association with IBS symptoms, and the purpose of this study was to investigate if there is a clear relationship in microbial composition and relative abundance of microbial taxa in feces of persons diagnosed with IBS. Fecal microbiota profiling was done in a group of nine clinically confirmed IBS patients and 6 corresponding healthy controls, based on species specific 16s RNA gene. No statistically significant differences in Alpha and Beta diversity indices were found.
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